Controversies in infection: infection control or antibiotic stewardship to control healthcare-acquired infection?

Despite record resource being devoted to the control of healthcare-acquired infection (HCAI), rates have never been higher. Although the discovery of the contagiousness of puerperal sepsis by Alexander Gordon heralded the golden era of bacteriology and antibiotics, this led to a belief that infection was beaten. This in its turn may well have led us into a false sense of security and an over-reliance on antibiotics. Modern medicine has built many of its advances on a need for antibiotics, but their very success has led to huge over-use and resulting problems of resistance. Compounded by the absence of a good antibiotic pipeline we are now being forced to address the paradox of antibiotics; namely that they may actually be causing many HCAIs. Not only Clostridium difficile infection, but many others such as those caused by meticillin-resistant Staphylococcus aureus, are more or less completely contingent on antibiotic prescribing. Control of prescribing would probably be just as effective a measure in our fight against HCAI as conventional infection control measures. Arguably, traditional infection control is akin to fire-fighting and antibiotic stewardship to prevention. (C) 2009 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.